Journal Watch - Mortality
Improving Incident ESRD Care with Transitional Care Units
Patients who transition onto dialysis are at high risk for morbidity and mortality—along with high costs. Transitional care units use the first 30 days of treatment for systematic onboarding that includes education and informed options choice—and may be especially helpful to those who start treatment emergently. Read the abstract.
Read the abstract » | (added 03/16/2018)
Standard Kt/V urea Targets Less Useful for Home HD
When patients do home HD more often than three times a week, do the Kt/V urea targets still predict outcomes? Not all that well, suggests a new study. Multivariate regression analysis of 109,273 standard in-center HD patients compared to 2,373 home HD patients found that while a lower Kt/V urea (<2.1) did predict higher blood pressure in both groups, it did not predict metabolic control in either group. For those on home HD, a low Kt/V did not predict hospitalization, mortality, or technique failure, though it did for in-center patients. The authors concluded that the current Kt/V urea targets “have limited utility” for home HD.
Read the abstract » | (added 02/15/2018)
Survival in Those Eligible for BOTH PD or Standard In-center HD
Yes, this is yet another survival comparison. A study of almost a decade of people (N=2,032) starting dialysis at seven Ontario clinics looked at mortality only among those who were judged to be suitable for either PD or standard in-center HD by a multidisciplinary team. Both options offered similar survival.
Read the abstract » | (added 12/14/2017)
PD in PKD?
There is yet more evidence that people with PDK can successfully do PD. Researchers in Peking analyzed survival data from people with PKD between1993 and 2015 on PD vs. HD. Additionally, they matched PD patients who did and did not have PKD. Neither PD nor PKD independently predicted mortality.
Read the abstract » | (added 09/15/2017)
PD vs. Standard HD for People with Cirrhosis
For cirrhotic people with kidney failure, data abstraction from the U.S. Nationwide Inpatient Study between 2005 and 2012 compared outcomes with PD and standard in-center HD. In-hospital mortality for those with ascites was significantly less with PD. In addition, PD hospital stays were shorter and costs were lower. Yet, just 1.7% of the sample was using PD.
Read the abstract » | (added 04/12/2017)
Results of a Metaanalysis of Nocturnal vs. Standard HD
Researchers who looked at 28 studies of 22,508 patients found a mixed bag: comparable side effects and mortality between nocturnal and standard HD, less hospitalization with standard HD—but better heart health and physical quality of life with nocturnal HD, with fewer blood pressure medicines needed.
Read the abstract » | (added 03/09/2017)
The HEMO Study Returns with a New Message
“An index only on the basis of urea does not provide a sufficient measure of dialysis adequacy,” finds yet another reanalysis of the by-now-ancient HEMO study data. Looking only at small uremic solutes—even non-urea wastes—did not predict all-cause mortality. Doing HD just three times a week made it impossible to remove enough solutes to matter.
Read the abstract » | (added 11/10/2016)
Time Matters: HD Kt Dose , Hospitalization, and Death
Does adding more HD benefit patients? Yes, finds a Fresenius study of 6,129 patients in Spain. There as a progressive increase in the risk of death for patients who were below the target Kt, and as Kt rose to reach and exceed the target, the risk declined, as did the risk of hospitalization. “Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk,” noted the authors.
Read the abstract » | (added 11/10/2016)
Overhydration and Mortality Risk on PD
When PD does not remove enough water, the resulting overhydration is a major risk factor for death. A study of 54 PD patients between 2008 and 2015 measured with bioimpedance technology were divided into normohydrated and overhydrated groups. Older age, low diastolic blood pressure and overhydration predicted mortality.
Read the abstract » | (added 08/09/2016)
Urea Alone is Not a Good Index of Dialysis Dose
All-cause mortality in the HEMO study was not significantly related to removal of small solutes in short, intermittent, standard HD. “Failure to achieve greater reductions in solute levels may explain the failure of high Kt/V urea treatment to improve outcomes,” the authors note. (Yet another reanalysis of the HEMO study data has confirmed the obvious…)
Read the abstract » | (added 04/12/2016)